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A Capability Framework for NHSScotland’s Knowledge Broker Network:

Working Together to Translate Knowledge into Action to Improve Scotland’s Health and Care

The knowledge, skills and values required to create and maintain a coordinated knowledge broker network, providing a portfolio of evidence-based services to help translate knowledge into frontline practice and Healthcare Quality Outcomes.

Version 1.0 October 2012

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Contents Summary .................................................................................................................................................................................................................. 3

1. Strategic Context ................................................................................................................................................................................................. 5

2. Definitions ............................................................................................................................................................................................................ 6

3. How will this framework be used? ...................................................................................................................................................................... 7

4. Methodology - how the framework was produced ............................................................................................................................................. 7

5. Structure of the Capability Framework ............................................................................................................................................................. 10 Capability Statement 1: The knowledge broker network builds organisational capacity and workforce capability for using knowledge, across the whole system of health and social care. ............................................................................................................................................................... 11 Capability statement 2: The knowledge broker network operates as a coordinated and connected system, locally and nationally, based on strong relationships across functions and organisations, to deliver all elements of the Knowledge into Action change package and vision in support of the Quality Outcomes. ......................................................................................................................................................................... 15 Capability statement 4: The knowledge broker network delivers and creates knowledge in actionable formats, embedding knowledge in healthcare systems and practitioner workflow so that application of knowledge becomes an integral part of routine healthcare processes. ........ 23 Capability statement 5: The knowledge broker network supports exchange and dissemination of knowledge among people and across organisations by facilitating relationships and interactions based on sharing knowledge. ..................................................................................... 26

6. References .......................................................................................................................................................................................................... 29

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Summary

This framework describes the knowledge, skills, values and behaviours required to create a coordinated knowledge broker network, combining complementary strengths to support practitioners to apply knowledge in frontline practice, and to embed knowledge in healthcare improvement. Based on consultation and research evidence, it defines capabilities and learning outcomes which can be used to support local and national development of a collaborative knowledge broker network, deploying the full range of knowledge into action support described in the Knowledge into Action strategic review. The table below summarises the capabilities and their relationship with the components of the Knowledge into Action vision and change package.

Capabilities and learning outcomes. Element/s of Knowledge into Action change package.

Capability Statement 1: The knowledge broker network builds organisational capacity and workforce capability for using knowledge, across the whole system of health and social care. Learning outcomes: 1.1 Values Base of Knowledge into Action 1.2 Knowledge into Action Contribution to Quality of Health and Care 1.3 Applying knowledge to improve health and care processes and outcomes. 1.4 Leadership and change management 1.5 Developing workforce capabilities in knowledge into action 1.6 Modernising use of the physical library resource

Building organisational capacity and capability for use of knowledge. Modernising use of the physical library resource.

Capability statement 2: The knowledge broker network operates as a coordinated and connected system, locally and nationally, based on strong relationships across functions and organisations, to deliver all elements of the Knowledge into Action change package and vision in support of the Quality Outcomes. Learning outcomes: 2.1 Collaboration 2.2 Coordination of knowledge broker network processes 2.3 Working as teams, communities and networks

Operating as a coordinated knowledge broker network.

Capability statement 3: The knowledge broker network identifies knowledge needs; sources, combines and presents knowledge from research, practice and experience, to help improve health and wellbeing for individuals and populations in local contexts. Learning outcomes:

Sourcing and synthesising knowledge from research, practice and experience.

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3.1 Different forms of knowledge 3.2 Identifying knowledge needs 3.3 Sourcing and evaluating research knowledge 3.4 Capturing tacit knowledge 3.5 Using data and measures from practice 3.6 Horizon-scanning and updating knowledge 3.7 Creating new knowledge 3.8 Combining, organising and summarising knowledge: 3.9 Reporting and presenting knowledge 3.10 Sharing and disseminating knowledge assets Capability statement 4: The knowledge broker network delivers and creates knowledge in actionable formats, embedding knowledge in healthcare systems and practitioner workflow so that application of knowledge becomes an integral part of routine healthcare processes. Learning outcomes 4.1 Defining actionable knowledge solutions 4.2 Embedding actionable knowledge at point of care 4.3 Contextualising and personalising knowledge 4.4 Coding and classifying point of care knowledge

Delivering knowledge in actionable formats.

Capability statement 5: The knowledge broker network supports exchange and dissemination of knowledge among people and across organisations by facilitating relationships and social interaction based on sharing knowledge. Learning outcomes 5.1 Relational and social knowledge methods 5.2 Facilitating sharing of knowledge 5.3 Supporting therapeutic use of information and knowledge 5.4 Social use of knowledge in education 5.5 Creating connections 5.6 Mentoring, coaching, buddying 5.7 Fostering innovation 5.8 Supporting spread of improvement

Facilitating social and relational use of knowledge.

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1. Strategic Context 1.1 The Knowledge into Action Review was commissioned by NHS Education for Scotland and Healthcare Improvement Scotland to help align the use of knowledge in NHSScotland with the aims of the Quality Strategy (1) and the 20:20 vision of integrated health and social care (2). This strategic review was designed to mobilise NHSScotland’s strong knowledge infrastructure, for example, in the form of the Knowledge Network (www.knowledge.scot.nhs.uk), its national librarian network, SIGN guidelines and other evidence products. It aimed to define a new national approach to translate this knowledge into frontline practice, planning and policy , by:

• supporting practitioners to apply knowledge in frontline practice.

• embedding knowledge in healthcare improvement activities. 1.2 The outcome of the review (3) proposes a vision of a network of knowledge brokers, integrated with improvement and clinical teams. This knowledge broker network will deliver an evidence-based portfolio of knowledge into action support with a direct impact on frontline clinical care and which will underpin the efforts of NHSScotland and its partners to plan and deliver services based on safety, effectiveness, and better experience for patients, users and carers. 1.3 The review’s analysis of forty-four models of knowledge translation, assessing their relevance to frontline healthcare improvement (4), has informed a new, dynamic knowledge into action approach which combines the strengths of evidence-based practice and quality improvement. This model proposes teams, patients and carers co-creating knowledge as part of continuous learning and improvement by:

• combining research evidence with the experience of teams, patients and carers, and data from practice activity.

• customising research knowledge to the working context

• personalising knowledge to individual patient care

• understanding, managing and using data on variation in practice to build the knowledge base for frontline delivery of care, and

• embedding knowledge in the workflow of practitioners. 1.4 This approach augments the “know-what” of evidence-based practice which focuses on the question “can this intervention work?”, with the “know-how” of quality improvement, to inform “how might we make it work better in this setting and for this patient?” 1.5 The Knowledge into Action review converts this model into practical activities and support services for delivery by the knowledge broker network. A survey of local knowledge services (5), combined with evaluation of a portfolio of test of change projects in NHS Boards (6), using a tailored impact assessment framework, has informed design of a “change package” of knowledge management approaches to develop and spread across NHSScotland. This comprises the following elements:

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Coordination of the network of knowledge brokers, to delivering the following evidence-based suite of services to help improve clinical practice and deliver better healthcare outcomes:

a) evidence search and synthesis – combining research with evidence from the experience of teams, patients and carers;

b) delivering knowledge in actionable formats – for example care bundles, decision aids, pathways, decision support;

c) supporting person to person exchange and dissemination of knowledge, through methods such as communities of practice;

d) building organisational capacity and culture for use of knowledge through leadership, and building knowledge management roles and skills. 1.6 This framework proposes the knowledge, skills and attitudes required by the knowledge broker network to deliver this portfolio of support. Based on published research evidence, it is a first of its kind and should be regarded as a work in progress, to be tested and refined in practice as part of the implementation of Knowledge into Action.

2. Definitions

2.1 This capability framework provides a broad outline of what Scotland’s network of knowledge brokers collectively should be able to do in practice (7).This emphasis on collaboration and networking as a mandatory capability is a unique, defining feature of the framework and is central to integrating knowledge support with healthcare improvement as defined in the Knowledge into Action review. 2.2 As a capability framework, it goes beyond definition of knowledge and skills, as commonly found within competency frameworks, to describe how these will be applied in practice. 2.3 This framework defines the knowledge, skills, behaviours and values that will enable the coordinated knowledge broker network as a whole to integrate with clinical and improvement teams, providing the full package of services that support practitioners to apply knowledge in frontline practice, and embed knowledge in healthcare improvement. As outlined in “Getting Knowledge into Action for Healthcare Quality” (3), Scotland’s knowledge broker network will operate through collaboration by knowledge brokers from a range of backgrounds – including, for example, librarians, researchers, clinical effectiveness and clinical governance officers, public health officers, information analysts and eHealth managers. This collaborative approach combines complementary strengths to deliver all elements of the Knowledge into Action change package, to help translate knowledge into practice and systems improvement. 2.4 In this context, a knowledge broker is defined as an active participant in this coordinated knowledge broker network, bringing specific capabilities and a commitment to collaborating with others’ complementary strengths, to form a coordinated whole system of knowledge into action support.

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3. How will this framework be used?

3.1 The framework is designed to support all participants in the knowledge broker network in developing their capabilities to work and lead in collaboration within this networked model. This includes supporting the library workforce to deploy traditional skills in a new context focused on application of knowledge to practice, through collaboration with partners in the knowledge broker network, and closer partnership with clinical and improvement colleagues. 3.2 The framework aims to help knowledge brokers, educators, service managers and line managers to envisage the future state of Knowledge into Action, in terms of what the knowledge broker network as a whole should be able to do by the time the Knowledge into Action implementation plan is fully delivered, at end of March 2016. It will support both national and local service planners and workforce development planners to achieve this outcome. 3.3 Knowledge Management Executive Leads, Improvement Leads and senior Knowledge Managers, locally and nationally, will use the framework as an assessment tool to plan for configuring, developing and deploying the knowledge broker network locally and nationally to support healthcare improvement priorities. 3.4 Trainers, line managers supporting staff in their personal and professional development, and staff undertaking self-directed learning, will use the framework to design and deliver learning and development to build the required capabilities across the knowledge broker network. The framework should underpin formal educational programmes, as well as informal learning – e.g. mentoring, work-based learning and self-directed reflection. 3.5 Working and learning in the context of this networked approach, knowledge brokers will use this Framework to support their own and their partners’ full potential • developing their ability to adapt and apply knowledge and skills • sharing learning from experience • envisaging the future of the coordinated knowledge broker network applying the portfolio of knowledge into action services, and contributing to making it happen

4. Methodology - how the framework was produced

4.1 Literature Review – see attached Annex for full details.

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4.1.1 This capability framework draws upon a comprehensive literature review to identify and analyse research on the knowledge, skills, values and attitudes relating to the knowledge broker role in health and social care. 4.1.2 The following databases were searched via The Knowledge Network:

Cochrane Library including Centre for Reviews and Dissemination database Medline EMBASE CINAHL PsycInfo ASSIA HMIC ERIC EMBASE

LISTA Campbell Collaboration Biomed Central Web of Science Social Science Citation Index Google search World Health Organisation website

Some sources were identified via citation searches or from articles identified in the original K2A review. 4.1.3 Search terms used: knowledge translation knowledge broker* knowledge exchange knowledge gap evidence gap knowledge role* capabilit* framework* competenc* framework health librarian clinical librarian informationist clinical information specialis* outreach librarian clinical teams outreach librarian knowledge manage*

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4.1.4 Abstracts were reviewed and fulltext obtained for articles which described knowledge broker roles. Given the pragmatic nature of this literature overview, where available, systematic reviews were used as the main source of information rather than the primary research articles they covered. References to knowledge, skills, values and attitudes were extracted and common themes identified across articles. Themes were selected and described below where they occurred across more than one primary article.

4.2 Learning from tests of change

The evaluation of the portfolio of tests of change conducted by NHS Boards during the Knowledge into Action review (6), and the discussions during webinars and face to face meetings of test of change participants during August 2011 to February 2012, provided valuable prompts and ideas as to capabilities and training needs to support future development of the knowledge broker role.

4.3 Consultation

4.3.1 Interviews During June to August 2012 a NES Knowledge Manager visited knowledge services in every territorial and special health board and interviewed staff. These discussions gathered feedback and ideas on implementation of Knowledge into Action; information on current tests of change; support and training needs/ideas to underpin implementation. The Knowledge Manager encouraged information about local tests of change and examples of good practice to be shared via an online form and the Bringing Knowledge Together community website. Thematic clusters of capabilities emerged from these conversations

• Staff competencies

• Culture

• Infrastructure

• Policy 4.3.2 Workshops The outcomes of librarian workshops in 2012 following were taken into account:

• February 2012: NHS Librarian meeting – opportunity for progress update on tests of change and consultation on implementation of Knowledge into Action, including training and support needs.

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• Special Health Boards - A workshop held in August 2012 for the knowledge services in the special health boards identified options to work and learn together.

• Training opportunities - A conversation with SHINE CPD group was initiated to propose opportunities to jointly provide training opportunities and prevent duplication of effort.

4.4 Iterative development through piloting and feedback

The capability framework in its current draft form is a work in progress. In line with improvement (“PDSA”) principles, the aim is to pilot and evaluate the framework in a systematic way, aligned with a programme of learning and development, during implementation of Knowledge into Action. The Knowledge into Action Change Team wishes to consult with Boards on the best approach to piloting. For example, some Boards and knowledge broker groups may volunteer to test particular elements of the Framework, perhaps in association with tests of change which focus on particular components of the change package.

5. Structure of the Capability Framework

5.1 The Framework describes the capabilities required to deliver all elements of the Knowledge into Action change package. It highlights “core capabilities” – marked with a “C”. These are common capabilities which every member of the knowledge broker network can be expected to hold. The remainder are special capabilities which different participants in the network will contribute to the full spectrum of coordinated support. 5.2 Each capability is mapped to the Knowledge and Skills Framework (KSF) dimensions, to support staff, line managers and trainers in using this capability framework to support personal and professional development planning. It is recognised that different individuals will develop these capabilities to different levels, in line with local and national needs and staffing structures. The mapping to the KSF may also help in defining appropriate levels for different individuals. 5.3 The framework starts by defining the capabilities required to align knowledge broker activities with overarching healthcare policy and systems improvement. This is an essential first step in establishing the context for deploying the knowledge broker network to support healthcare priorities. It then highlights the capabilities required for collaborating within a knowledge broker network, underlining the need to bring together complementary skills and expertise, and to maximise use of available capacity across the whole healthcare system. Against this backdrop of organisational context and a networked implementation model, the framework then sets out the specific capabilities associated with knowledge search and synthesis, delivery of actionable knowledge, and facilitating relational and social use of knowledge.

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5.4 Underpinning the framework are a core set of attitudes and mind-sets which characterise the knowledge broker network’s contribution to healthcare improvement:

• Collaborative leadership

• Entrepreneurial approach

• Solution-focused mind-set

• Innovating

• Proactive approach

• Demonstrating professionalism

• Customer / User-centred approach

• Commitment to continuous learning

Capability Statement 1: The knowledge broker network builds organisational capacity and workforce capability for using knowledge, across the whole system of health and social care.

Learning outcomes Core? KSF mapping

Examples

1.1 Values Base of Knowledge into Action: Discuss the values shared by health and social care staff and relate them to own workplace values in delivering knowledge into action support.

C

C5

Presentation of KIA review and implementation to key leads in the health board. Involvement in local tests of change.

1.2 Knowledge into Action Contribution to Quality of Health and Care: 1.2.1 Describe the policy context for delivering Quality Outcomes across health and social care. 1.2.2 Discuss with colleagues the meaning of healthcare quality and Quality Outcomes for patients, service users, practitioners and organisations in terms of safe, effective and person-centred care across health and social care settings. 1.2.3 Reflect on and analyse the relationships between the Knowledge into Action vision and change package in improving quality of health and care, and delivering on the Quality

C C C

C4, C5

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Outcomes. Dementia exercise within Social Innovation Events 2011 Participation in programme of tests of change 2011-12 Evaluation report for tests of change. Proposal for mapping knowledge resources and processes in health and social care partnerships; designing more collaborative and coordinated approaches. Development of local Knowledge into Action strategy in Health Scotland, NHS Lothian, NHS Borders, NHS Lanarkshire and others.

1.3 Applying knowledge to improve health and care processes and outcomes. 1.3.1 Describe health and social care as processes and systems from the perspective of the service user, recognising the interdependence of service users, practitioners, managers, support staff, context, procedures and underpinning knowledge support, coming together to meet the needs of individuals and communities. 1.3.2 Identify opportunities for improving quality of health and care through application of knowledge. Apply improvement principles and tools to design, implement and measure impact of tests of change or other improvement methods to apply elements of the Knowledge into Action change package to support delivery on the Quality Outcomes. 1.3.3 Apply appropriate measurement techniques to assess impact of Knowledge into Action initiatives on awareness, engagement, user satisfaction, decisions, practice and ultimately service needs and outcomes. This includes setting baselines, sampling and collecting data. 1.3.4 Describe and develop the role of knowledge into action within an assets-based approach to improving quality of care, i.e. building on existing strengths in services and capabilities to mobilise knowledge and help deliver better outcomes.

C C C C

C4, C5

1.4 Leadership and change management: 1.4.1 Exert influencing and negotiation skills to engage clinical, senior management and practitioner engagement in implementing Knowledge into Action. 1.4.2 Lead and manage change in use of knowledge in practice, policy and planning in complex organisations, including strategic management of people

C4, C5, G7

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and their work to support more effective application of knowledge. 1.4.3 Plan and implement local Knowledge into Action strategy to embed knowledge support in the work of frontline practitioners, clinical and social care teams, and service improvement teams. 1.4.4 Champion and promote at all levels in the organisation the application of knowledge to improve quality of health and care. 1.4.5 Contribute to and encourage ideas and innovation in facilitating the application of knowledge to improve quality of health and care. 1.4.6 Demonstrate collaborative, distributed leadership, working in partnership with other knowledge brokers to promote the principles, practice and benefits of Knowledge into Action.

C C C

Plan in Tayside to embed support in their clinical systems using a decision support platform. Practice Educator project – train the trainer approach Information literacy training for end users. Knowledge into action training, face to face and WebEx with patient safety fellows and GPs. Knowledge into Action elearning module as part of Quality Improvement elearning. Physical resource working groups Document requesting project.

1.5 Developing workforce capabilities in knowledge into action: 1.5.1 Design, implement and evaluate strategic plans, learning methods and opportunities to support health and social care staff to deploy knowledge into action capabilities – sourcing, creating, evaluating, combining, sharing knowledge - to improve day to day practice, health and care services, and support education and research. 1.5.2 Understand and apply different pedagogical approaches to develop workforce capabilities in translating knowledge into action. 1.5.3 Understand and apply disparate mechanisms of supporting learning including web-based learning, virtual classrooms, social networking, face to face training, digital collaboration, individual and group reflection, etc.

C2, G1

1.6 Modernising use of the physical library resource: 1.6.1 Apply improvement thinking to modernise management of physical library resources, to optimise efficiency and user experience, support collaboration and innovation, and release library staff to work in closer partnership with clinical and

C4, G2

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improvement teams. Examples of learning and development opportunities

Existing opportunities Attendance at K2A librarians and Health Board executive lead meetings and WebEx calls How to use elearning tools to create and reuse objects to create modules to support KM skills Quality Improvement methodology and tools courses and skill development opportunities eg Quality Improvement eLearning modules Suggestions for future learning programme How to make the best use of WebEx to train end users Influencing and negotiating skills Use of social media to support spread and dissemination of knowledge How to deliver Train the trainer sessions Building relationships using social marketing Exploring different methods for recording and analysing feedback

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Capability statement 2: The knowledge broker network operates as a coordinated and connected system, locally and nationally, based on strong relationships across functions and organisations, to deliver all elements of the Knowledge into Action change package and vision in support of the Quality Outcomes.

Learning outcomes Core? KSF

mapping Examples

2.1 Collaboration: 2.1.1 Work effectively with local and national partners in the knowledge broker network, appreciating others’ complementary perspectives and responsibilities in providing the full package of Knowledge into Action support. 2.1.2 Reflect on and analyse own contribution and contribution of own team to the knowledge broker network, locally and nationally. Identify gaps in support compared with the Knowledge into Action change package and vision. Build relationships and processes to address those gaps. 2.1.3 Analyse the evidence base for a range of knowledge broker roles partnering with clinical teams and improvement teams. Reflect on relevance to own contribution and team’s contribution. Identify and act on opportunities for improving these partnerships. 2.1.4 Discuss the principles of co-creation and co-production as they relate to Knowledge into Action. Identify opportunities to engage partners, including service users, in developing services and resources.

C C

C1, C2 CLEAR, Palliative care guideline project, Sepsis and VTE project, and Older People’s collaborative are all examples of working collaboratively to support the search and synthesis. GG&C test of change working with ICU. A&A test of change in urogynaecology unit. Health literacy and information partnership training. Document Delivery group utilised LEAN methodology to map out new processes. LEAN methodology used to review processes in GG&C Knowledge Services.

2.2 Coordination of knowledge broker network processes: 2.2.1 Apply appropriate improvement methods – e.g. LEAN, process mapping – to analyse and critique current knowledge support processes as they operate across functions and organisations, locally and nationally; identify and act on scope for improvement.

C

C4, G5, IK1

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2.2.2 Actively contribute to creation and implementation of common standards and processes to underpin optimally efficient and equitable knowledge into action support locally and nationally. 2.2.3 Actively contribute to designing, implementing and evaluating processes that coordinate the different elements of knowledge into action to support all stages of improvement – e.g. sourcing and capturing knowledge; packaging as actionable knowledge; exchanging and disseminating knowledge.

C C

Palliative care guideline project, support for Sepsis and VTE collaborative and Older People’s Collaborative all involve coordinating various knowledge into action processes across Boards.

2.3 Working as teams, communities and networks 2.3.1 Discuss with colleagues the principles, operations and development of teams, communities of practice and networks, as they apply to local and national knowledge into action support for improvement. Reflect on own contribution within cross-cutting knowledge into action teams supporting improvement, and to the operation of local and national knowledge broker networks as a community of practice. 2.3.2 In planning and implementing improvement initiatives, describe and discuss with others the roles and responsibilities of members of a supportive knowledge into action team, working across functions and organisations, in helping to ensure a successful outcome. 2.3.3 Apply appropriate techniques – e.g. social network analysis – to analyse relationships between functions and specialisms contributing to delivery of the knowledge into action vision and change package. Identify opportunities for improvement. 2.3.4 Actively build relationships based on mutual support and mutual learning within the local and national knowledge broker networks, maximising synergies across functions and specialist areas of knowledge.

C C C

C4, G5, IK1

Older People’s Collaborative in NHS Tayside in which the local librarian supported the development of the community of practice. Use of Bringing Knowledge Together website to share experiences around implementing Knowledge into Action workstrands – Knowledge Search and Synthesis and Modernising use of the Physical Library Resource. Librarians and other knowledge brokers in coordinating roles for Knowledge into Action implementation workstrands.

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2.3.5 Contribute to a culture of continuous improvement and continuous learning within the knowledge broker network, through collaborative planning, reflection on progress and a willingness to learn from both successes and mistakes. 2.3.6 Demonstrate the principles of collaborative, distributed leadership in working with partners in the knowledge broker network to promote the application of knowledge to support frontline practice and systems improvement.

C C

Examples of learning and development opportunities

Existing opportunities Training to use LEAN methodology QI eLearning modules on using QI tools Suggestions for future learning programme Using Social Network Analysis tools Role of CoPs in quality Improvement Awareness of social media tools and there uses to promote quality and knowledge management

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Capability statement 3: The knowledge broker network identifies knowledge needs; sources, combines and presents knowledge from research, practice and experience, to help improve health and wellbeing for individuals and populations in local contexts.

Learning outcomes Core? KSF

mapping Examples

3.1 Different forms of knowledge: 3.1.1 Describe different forms of knowledge, including:

• explicit and tacit knowledge;

• “know-what”, “know-how”, “know-who”

• knowledge derived from research, practice, and experience of teams, practitioners and service users.

• knowledge from population data and statistics, evaluation, policy and legislation and business intelligence

3.1.2 Reflect on the purpose of each type of knowledge, how each is generated and validated, the differences between knowledge and evidence, and how each type of knowledge contributes to planning and decision-making to improve quality of health and care. 3.1.3 Discuss with colleagues the differences between knowledge to support small-scale local change and generalisable knowledge that needs to be transferred and applied on a large-scale across contexts.

C C

IK3 Examples of different types of knowledge retrieved through searching. Eg the Sepsis and VTE searches identifying ‘know what’ , ‘know how’ and “know-who”.

3.2 Identifying knowledge needs: 3.2.1 Apply enquiry techniques – e.g. interview, focus group, questionnaire observation, listening and responding, concept mapping – to define real - as opposed to perceived - knowledge needs of health and social care staff in order to improve quality of health and care.

IK3 Reference interviews prior to searching Focus groups and questionnaires used to conduct knowledge needs analysis in NHS Greater Glasgow and

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3.2.2 Apply question definition techniques, e.g. identifying Background versus Foreground questions; PICO (Population- Intervention-Comparison- Outcome) , SPICE (Setting – Perspective- Intervention- Comparison- Evaluation), to align retrieval of knowledge with specific knowledge needs.

Clyde, Ayrshire and Arran and other Boards. PICO in common use to support enquiry services.

3.3 Sourcing and evaluating research knowledge: 3.3.1 Identify online and offline sources of research knowledge in health, social care and related areas, identifying the scope and strengths that make them suitable for different types of knowledge needs. Discuss with colleagues the differences between primary, secondary and tertiary sources, and the types of knowledge need each is designed to support. 3.3.2 Apply appropriate search techniques to retrieve knowledge from these sources at a level of sensitivity and specificity appropriate to different knowledge needs. 3.3.3 Source, combine and summarise knowledge to provide rapid responses to clinical enquiries at point of care. 3.3.4 Critically reflect on the nature of credibility and evaluation approaches for different types of research. Apply critical appraisal guidelines, quality checklists and other evaluation methods and tools as appropriate.

IK2 CLEAR service Tests of change of clinical enquiry services in GGC, A&A. Routine Literature searching for users Rapid Search and Synthesis service and Systematic Search Service – NHS Greater Glasgow and Clyde. Critical appraisal skills training – NHS Grampian.

3.4 Capturing tacit knowledge: 3.4.1 Identify and deploy appropriate techniques to capture experiential and emotional knowledge – e.g. use of narrative / storytelling, guided reflection, case studies, social networking, peer assist reviews, after action reviews, knowledge cafes and markets.

IK2 Scottish Health Council knowledge management events – capturing service user stories. Peer assist sessions to gather expert input to knowledge needs analysis for new Knowledge Network portals.

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Knowledge cafes used frequently at knowledge management events. Gathering and presenting improvement stories for Scottish Stroke Knowledge into Action Community

3.5 Using data and measures from practice: 3.5.1 Identify local and national sources of data and statistics from practice, performance, cost, service activity, population health, workforce management etc. Describe the purpose of each source and its role in decision-making about individual and population health. 3.5.2 Help to identify appropriate tools for data collection and analysis in improvement initiatives. 3.5.3 Contribute to the collection, analysis and interpretation of data from improvement initiatives. 3.5.4 Contribute to discussion of causes of variation from guidelines and standards, distinguishing between variation arising from service user needs and variation arising from systems and practitioner behaviour. 3.5.5 Identify, signpost and promote use of appropriate quality measures to provide evidence of improving practice.

IK2 NHS Fife lung cancer knowledge test of change was initiated following the gathering of local data which indicated a problem in adherence to cancer pathways in acute medical wards. Older People Collaborative in Tayside supports the recording of audit data. NHS Greater Glasgow and Clyde creating repository of information about clinical tools and measures.

3.6 Horizon-scanning and updating knowledge: 3.6.1 Apply knowledge search, organisation, presentation and communication techniques to help practitioners and managers keep up to date with new knowledge in their fields of interest – e.g. through current awareness bulletins, newsfeeds, social networking etc.

IK2 Many examples of current awareness bulletins and newsfeeds in clinical and management topics.

3.7 Creating new knowledge: IK2

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3.7.1 Identify gaps in the existing knowledge base, through review of results of knowledge searches and use of sources such as the James Lind Library. 3.7.2 Contribute to creation of new knowledge through empirical testing and participation in evaluation, research and development initiatives. 3.8 Combining, organising and summarising knowledge: 3.8.1 Identify and deploy appropriate information management techniques to describe, categorise and organise knowledge from different sources in order to support easy retrieval. This includes, for example:

• Definition and application of metadata and vocabulary standards – including cataloguing, indexing, classification, tagging, use of taxonomies and folksonomies

• Defining themes and concepts specific to user needs; defining relationships between concepts, and extracting these concepts from the material retrieved through knowledge search and capture stages.

• Defining website architecture and navigation.

• Paraphrasing, summarising and annotation techniques to provide overviews of key points relevant to the user’s needs.

IK3 Fife Lung Cancer test of change combines and displays local and national guidance, with metadata and subject indexing to support effective retrieval. Older People’s Collaborative – development of a community website organising local and national knowledge to support improvement. Development of health board internet and intranet websites Production of evidence digests, reference lists, annotated bibliographies. Thematic analysis within systematic search service in NHS Greater Glasgow and Clyde.

3.9 Reporting and presenting knowledge: 3.9.1 Deploy a range of techniques to report and present knowledge in a way that best suits user needs. This includes, for example,

IK2 Search results for Sepsis and VTE Collaborative packaged in a manner tailored to audience needs.

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• Structured templates and reports, in online or hard copy.

• Graphical visualisation as topic maps and diagrams

• Use of hyperlinks to connect summary statements to underlying evidence.

• Use of predefined searches to continuously update knowledge.

• Use of newsfeeds, Twitter, community webspaces and other social media to format outputs in a way that reaches key target audiences

• Embedding knowledge in elearning products, social media, videoclips, podcasts etc.

• Producing rapid overviews and digests of evidence.

• Producing scoping overviews of the knowledge base in a defined area.

• Writing reports for publication.

Examples of podcasts, elearning products contributed to Knowledge Network communities of practice. Creation of elearning resources that embed evidence and best practice.

3.10 Sharing and disseminating knowledge assets: (see also Capability 5 below - social use of knowledge). 3.10.1 Create and disseminate knowledge assets arising from knowledge search and capture, for example, by:

• Hosting and indexing searches and reports on the Knowledge Network or community websites.

• Using open access and traditional publishing channels as most appropriate to reach target audiences.

• Embedding knowledge assets in learning resources and programmes.

• Using social media channels to disseminate knowledge assets.

IK2 Sepsis and VTE website hosts outputs from search and synthesis. National Older People Collaborative planning to display search results and reports on community website.

Examples of learning and development opportunities

Existing opportunities Literature searching Rapid search and synthesis Digest writing Cataloguing and indexing Suggestions for future learning programme Social media tools Advanced metadata management including semantic web approaches.

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Capability statement 4: The knowledge broker network delivers and creates knowledge in actionable formats, embedding knowledge in healthcare systems and practitioner workflow so that application of knowledge becomes an integral part of routine healthcare processes.

Learning outcomes Core? KSF

mapping Examples

4.1 Defining actionable knowledge solutions: 4.1.1 Discuss with colleagues the range of actionable knowledge formats that help to embed knowledge in healthcare systems and practitioner workflow – e.g. decision aids, checklists, pathways, evidence bundles, mobile apps, decision support. 4.1.2 Help practitioners to identify the actionable knowledge solutions best suited to specific knowledge needs. 4.1.3 Understand, and signpost practitioners to, actionable knowledge sources, including third party and other specific tools e.g. Dynamed, pathway publication toolkit, mobile apps Knowledge Network evidence and guidance search. 4.1.4 Understand the capabilities of mobile devices, tablets, smartphones and other devices to support use of knowledge at the point of care. 4.1.5 Explain how the sourcing, combining and organisation of knowledge in capability 3 contributes to creation of actionable knowledge solutions.

C

IK2 Pathway publication toolkit Mobile Apps area within The Knowledge Network

4.2 Embedding actionable knowledge at point of care 4.2.1 Support the design, production and implementation of actionable knowledge solutions to align with practitioner needs, workflow and healthcare processes. 4.2.2 Understand and describe the different ways by which actionable knowledge can be hosted or incorporated into clinical systems to enhance standardised patient care and evidence-based decisions. Such approaches include links to online guidelines and evidence summaries, specific pointers,

IK2 NHS Fife tests of change – creation of toolkit for use on ward to support perioperative care of diabetes patients; use of browser plug-in to support ward access to local cancer pathways. Planned development of Mobile apps for Sepsis and CLEAR.

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and integrated decision support based on research evidence and analysis of practice data. 4.2.3 Apply information management techniques to structure, package, describe and index actionable knowledge – e.g. clinical guidelines, decision support tools, evidence based clinical pathways- to facilitate easy retrieval at point of care and links to clinical systems .

EBMEDS project in Tayside to embed knowledge support in Electronic Health Record systems. Point of care plug-in

4.3 Contextualising and personalising knowledge at point of care. 4.3.1 Discuss the difference between local and generalisable knowledge. Customise knowledge to support use in specific work settings without detracting from the integrity of underlying evidence base. 4.3.2 Discuss with colleagues the limitations of research knowledge and research-based guidelines in supporting care of individual service users in real-life work environments (for example, in care of older people with co-morbidities and polypharmacy not reflected in controlled trials). Identify techniques for tacit and social knowledge management (see capabilities 3 and 5) that can complement research knowledge with knowledge from experience and practice.

IK2 NHS Fife Lung Cancer test of change - Inclusion of local knowledge in point of care browser plug-in NHS Tayside publication of local pathways via pathway publication toolkit, linked to national guidelines and international evidence within the Knowledge Network. Communities of practice and problem-based small group learning combine use of research evidence and guidelines with sharing experience of local implementation.

4.4 Coding and classifying point of care knowledge: 4.4.1 Understand the basis, application and limitations of different clinical and care coding systems, classifications and related vocabularies. Appreciate the importance of codes and terminology in point of care knowledge support and decision support software 4.4.2 Explain the advantages and disadvantages of fully coded, part coded and

IK3 Mapping local clinical coding systems to decision support content within NHS Tayside pilot of EBMEDS decision support software.

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unstructured knowledge in enabling retrieval of knowledge and access to knowledge at point of care. 4.4.3 Use terminology and classifications appropriately to describe point of care knowledge and support links with clinical systems. 4.4.4 Recognise why coded data is needed to support service improvement and redesign, e.g. through the Quality and Outcomes Framework. 4.4.5 Explain the importance of coded data in clinical research, epidemiology, public health, local and national audit. 4.4.6 Demonstrate awareness of clinical terminologies used in clinical IT systems, such as the Read codes Clinical Terms Version 3 and SNOMED – CT (Systemised Nomenclature of Medicine Clinical Terms). 4.4.7 Demonstrate understanding of the national standards and conventions used by the NHS in coding clinical data e.g. ICD -10 (International Statistical Classification of Disease and Related Health Problems -10th edition) and OPCS-4 (Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures)and where these standards are used. Examples of learning and development opportunities Existing opportunities Using Community website toolkit to create websites Cataloguing and indexing Suggestions for future learning programme Metadata and Indexing standards Coding for healthcare systems Health informatics and clinical decision support eHealth system design Understanding apps and mobile technology

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Capability statement 5: The knowledge broker network supports exchange and dissemination of knowledge among people and across organisations by facilitating relationships and interactions based on sharing knowledge.

Learning outcomes Core? Indicative

KSF mapping

Examples

5.1 Relational and social knowledge methods: 5.1.1 Discuss the range of methods that support person to person exchange and dissemination of knowledge. 5.1.2 Select and deploy the methods best suited to meet specific needs and contexts. Methods include:

• Communities and networks of practice

• Educational detailing

• Educational outreach using social learning techniques.

• The spectrum of social networking tools – including blogs, wikis, discussion forums, sharing presentations and videos, chat rooms, webinars, twitter, etc.

• Peer assist and after action review methods.

C

C1, IK1, G1

Community of practice support via Knowledge Network. Use of social networking tools available via Knowledge Network and popular sources. Use of Moodle to support interactive learning. Peer assist reviews to support development of knowledge portals for social care. After action reviews following improvement programmes.

5.2 Facilitating sharing of knowledge: 5.2.1 Facilitate the sharing of knowledge within groups – e.g. problem-based small group learning, focus groups, multidisciplinary team meetings, communities of practice, use of social networking tools, etc.

C1, IK1, G1

5.3 Supporting therapeutic use of information and knowledge 5.3.1 Support health and social care staff in using information and knowledge as part of building the therapeutic relationship with service users. This can include, for example:

C1, G1 Health literacy training, information partnerships training.

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• Building health literacy among service users through methods such as “Teach Back” and “Ask me Three”.

• Use of information prescriptions to promote self-management.

• Creative use of reading and writing, on an individual or group basis, to support self-awareness and self-choice.

5.4 Social use of knowledge in education 5.4.1 Appreciate the educational value of social exchange of knowledge, and of application of knowledge to frontline practice and work in partnership with educators to promote use of these methods within social and work-based learning.

C1, G1 Children’s Services community website an example of embedding knowledge management in delivery of education

5.5 Creating connections. 5.5.1 Map flow of knowledge within and across networks, e.g. using social

network analysis. 5.5.2 Create linkages and connections with clinical and improvement

decision-makers and practitioners to facilitate a more effective exchange of knowledge.

5.5.3 Develop relationships across agencies in health and social care to

support effective transfer of knowledge as service users move across settings and services.

C1, G1, IK1

5.6 Mentoring, coaching, buddying 5.6.1 Deploy mentoring, coaching and buddying techniques to share

experience and expertise with colleagues. 5.6.2 Support others in using these techniques.

C1, G1,

5.7 Fostering innovation Facilitate dialogue and interaction to capture ideas, generate new perspectives and identify new uses for existing knowledge.

G2

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5.8 Supporting spread of improvement 5.8.1 Describe and deploy knowledge exchange and dissemination models and methods that support spread of improvement knowledge from small-scale initiatives to large-scale improvement – e.g.

• Communities and networks of practice.

• Embedding knowledge in formal education and continuous learning/ continuing professional development.

• Use of champions and extension agents

• Presentation via face to face and web or phone conferences

C1, G2, G7

Examples of learning and development opportunities

Existing opportunities Principles of communities of practice and how to facilitate successful communities of practice Mentoring skills Suggestions for future learning programme Use of social media in NHS Social network analysis KM tools and techniques of sharing knowledge Small group learning Coaching skills Information partnerships and health literacy Influencing skills Educational detailing

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6. References

1) Scottish Government. . The Healthcare Quality Strategy for NHSScotland. Edinburgh: Scottish Government. Edinburgh: Scottish Government. 2010 .www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf 2) Scottish Government . Achieving Quality in Scotland’s Healthcare. A “20:20” Vision. Edinburgh: Scottish Government. 2012. http://www.scotland.gov.uk/Topics/Health/Policy/2020-Vision/Strategic-Narrative 3) NHS Education for Scotland and Healthcare Improvement Scotland . Getting Knowledge into Action to Improve Healthcare Quality: Report of Strategic Review and Recommendations. Edinburgh: NHS Education for Scotland, 2012. http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4031966/K2AReview2012.pdf 4) Davies H, Powell A, Ward V, Smith S. Supporting NHSScotland in developing a new Knowledge-to-Action model. 2011 http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4002569/K2A_Evidence.pdf 5) Key data from the survey of NHS Scotland libraries and services June 2011 http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/1013282/Knowledge%20into%20Action%20Questionnaire%20final2.pdf 6) Knowledge into Action. Evaluation of test of change projects 2012. http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4016118/20120326%20evaluation%20report%20v1.pdf

7) NHS Education for Scotland (NES) Capability Frameworks http://www.advancedpractice.scot.nhs.uk/definitions/nhs-education-for-scotland-%28nes%29-capability-frameworks.aspx